| NPI | 1124115662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CT 022559) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 022559) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2010-09-15 |